MEDICARE: ROBIN MARISSA LIEVER ELLIS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT014911	GA

General Provider Information

NPI Number	:	1528673746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN MARISSA LIEVER ELLIS PT, DPT

Provider Business Mailing Address
First Line	:	1340 PASADENA AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3120
Country	:	US
Telephone Number	:	202-210-1131
Fax Number	:	404-592-8895

Provider Business Practice Location Address
First Line	:	1770 THE EXCHANGE SE STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2046
Country	:	US
Telephone Number	:	202-210-1131
Fax Number	:	404-592-8895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	04/28/2026

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